Assessment of Occupational Competence in Dementia: Identifying Key Components of Cognitive Competence and Examining Validity of the Cognitive Competency Test

Considering the links between dementia and everyday living, occupational therapists are called upon to make recommendations regarding appropriate living arrangements for persons with dementia. Re-framed as occupational competence, this is often accomplished by an evaluation of cognitive competence. Within the context of an aging population, a key question is how to best inform decisions regarding occupational competence, using cognitive competence as an indicator. The Cognitive Competency Test (CCT) is a tool used to evaluate cognitive competence and inform judgments about occupational competence in individuals with dementia. This thesis incorporates two studies that identified cognitive components that predict occupational competence in individuals with dementia, and examined the construct validity of the CCT, using a framework developed by Samuel Messick. A Delphi study, conducted amongst Canadian occupational therapists with experience in dementia care, generated a consensus regarding the components of cognitive competence essential to predict occupational competence in persons with dementia. A second study employed a retrospective chart review and examined the dimensional structure of the CCT and its relationship with other clinical measures typically used in dementia care. Occupational therapists identified ten cognitive components essential to predict occupational competence in individuals with dementia. The structure of the CCT is a unitary factor that demonstrates correlations to some clinical measures commonly used in dementia care. These findings give some support to the validity of the CCT and have implications for development of new measures and education regarding cognitive competence, pointing to the need to address other factors identified in the Delphi

Beyond traditional notions of validity: Selecting appropriate measures for occupational therapy practice.

Increasingly, tied to factors such as increased emphasis on accountability and health care spending restraints, occupational therapists are required to implement evidence-based practice. When implementing evidence-based assessment, it is critical that occupational therapists examine and challenge some of the assumptions underlying the current use of measures, as well as the conclusions being drawn from their use. In order to most effectively judge the appropriateness of measures informing their assessments, interventions and recommendations, occupational therapists must draw upon measurement theory and concepts. To date, occupational therapy literature has predominantly emphasized a narrow conceptualization of validity that focuses on empirical evidence. The work of Samuel Messick provides a more comprehensive framework of construct validity that considers both empirical and ethical issues. This framework binds the social consequences of assessment to the evidential basis of test interpretation and use, and challenges occupational therapists to broaden their consideration of validity by addressing both ethical and empirical issues when choosing measures